Psych Disorders May Predispose Soldiers to PTSD

Action Points

Explain that for military personnel, having at least one psychiatric disorder before deployment to Iraq or Afghanistan appears to increase the likelihood of developing posttraumatic stress disorder (PTSD) after deployment.

Note that factors suggestive of stress before deployment were also significantly associated with post-deployment PTSD, including the use of psychotropic drugs, the presence of major life stressors, and self-reported psychiatric history.

Note that limitations of the study included uncertainty about whether missing data from study participants introduced bias to the results, a lower-than-expected injury rate, the possibility that the results do not apply to the wider population of deployed military personnel, and possible recall and reporting bias.

For military personnel, having at least one psychiatric disorder before deployment to Iraq or Afghanistan appears to increase the likelihood of developing posttraumatic stress disorder (PTSD) after deployment, the prospective Millennium Cohort Study showed.

The presence of a psychiatric disorder pre-deployment was associated with a 2.52-fold (95% CI 2.01 to 3.16) greater likelihood of post-deployment PTSD, independent of injury severity and numerous other potential confounders, according to Cynthia LeardMann, MPH, of the Naval Health Research Center in San Diego, and colleagues.

The findings, which were reported in the May issue of Archives of General Psychiatry, "suggest that the Millennium Cohort or similar questionnaires completed before deployment might be useful to identify a combination of characteristics of deployed military personnel that could predict those most vulnerable or, conversely, those most resilient to post-deployment PTSD, thereby providing an opportunity for the development of pre-deployment interventions that may mitigate post-deployment mental health morbidity," the authors wrote.

Although previous studies have examined the association between pre-injury psychiatric status and post-injury PTSD, this is the first prospective study to do so, according to the researchers.

They used the Millennium Cohort Study, in which participants completed questionnaires at baseline and periodically thereafter. The current analysis included 22,630 military personnel who were deployed to Iraq or Afghanistan before completing at least one follow-up questionnaire.

Pre-deployment psychiatric disorders examined included depression, panic syndrome, or any other anxiety syndrome. PTSD was assessed on the PTSD Checklist-Civilian Version, which was a self-report measure of symptoms.

At baseline, 3.3% of the participants had at least one psychiatric disorder. During deployment, 0.8% sustained a physical injury, and at follow-up, 8.1% screened positive for PTSD.

After adjustment for baseline PTSD and other variables, the likelihood of screening positive for PTSD was increased for those with at least one baseline psychiatric disorder (OR 2.52).

The odds of developing post-deployment PTSD also increased with every 3-unit increase in the Injury Severity Score (OR 1.16, 95% CI 1.01 to 1.34), although the increase in the odds associated with baseline psychiatric disorders was independent of injury severity.

Other factors suggestive of stress before deployment were also associated with post-deployment PTSD, including the use of psychotropic drugs (OR 1.47), the presence of major life stressors (OR 2.78), and self-reported psychiatric history (OR 1.76) (P<0.05 for all).

The authors noted some limitations of the study, including uncertainty about whether missing data from study participants introduced bias to the results, a lower-than-expected injury rate, the possibility that the results do not apply to the wider population of deployed military personnel, possible recall and reporting bias from the use of self-reported data, and the possibility that the measures used to assess PTSD and other psychiatric disorders may not accurately reflect true clinical status.

This work represents report 10-03, supported by the U.S. Department of Defense, within work unit 60002. The work of one of LeardMann's co-authors in this project was supported by the Veterans Affairs Puget Sound Health Care System.

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